Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure.

Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

Variability in energy expenditure is much greater in males than females.

In mammals, trait variation is often reported to be greater among males than females. However, to date, mainly only morphological traits have been studied. Energy expenditure represents the metabolic costs of multiple physical, physiological, and behavioral traits. Energy expenditure could exhibit particularly high greater male variation through a cumulative effect if those traits mostly exhibit greater male variation, or a lack of greater male variation if many of them do not. Sex differences in energy expenditure variation have been little explored. We analyzed a large database on energy expenditure in adult humans (1494 males and 3108 females) to investigate whether humans have evolved sex differences in the degree of interindividual variation in energy expenditure. We found that, even when statistically comparing males and females of the same age, height, and body composition, there is much more variation in total, activity, and basal energy expenditure among males. However, with aging, variation in total energy expenditure decreases, and because this happens more rapidly in males, the magnitude of greater male variation, though still large, is attenuated in older age groups. Considerably greater male variation in both total and activity energy expenditure could be explained by greater male variation in levels of daily activity. The considerably greater male variation in basal energy expenditure is remarkable and may be explained, at least in part, by greater male variation in the size of energy-demanding organs. If energy expenditure is a trait that is of indirect interest to females when choosing a sexual partner, this would suggest that energy expenditure is under sexual selection. However, we present a novel energetics model demonstrating that it is also possible that females have been under stabilizing selection pressure for an intermediate basal energy expenditure to maximize energy available for reproduction.

Total energy expenditure is repeatable in adults but not associated with short-term changes in body composition.

Low total energy expenditure (TEE, MJ/d) has been a hypothesized risk factor for weight gain, but repeatability of TEE, a critical variable in longitudinal studies of energy balance, is understudied. We examine repeated doubly labeled water (DLW) measurements of TEE in 348 adults and 47 children from the IAEA DLW Database (mean ± SD time interval: 1.9 ± 2.9 y) to assess repeatability of TEE, and to examine if TEE adjusted for age, sex, fat-free mass, and fat mass is associated with changes in weight or body composition. Here, we report that repeatability of TEE is high for adults, but not children. Bivariate Bayesian mixed models show no among or within-individual correlation between body composition (fat mass or percentage) and unadjusted TEE in adults. For adults aged 20-60 y (N = 267; time interval: 7.4 ± 12.2 weeks), increases in adjusted TEE are associated with weight gain but not with changes in body composition; results are similar for subjects with intervals >4 weeks (N = 53; 29.1 ± 12.8 weeks). This suggests low TEE is not a risk factor for, and high TEE is not protective against, weight or body fat gain over the time intervals tested.

Mommio's Recipe Box: Assessment of the Cooking Habits of Mothers of Preschoolers and Their Perceptions of Recipes for a Video Game.

BACKGROUND: Vegetables are an important part of a healthy diet because they help prevent several chronic diseases. Mothers of preschoolers reported difficulty getting their young children to eat vegetables, and many did not know how to cook child-pleasing recipes. OBJECTIVE: The cooking habits of mothers of preschoolers, their perceptions of recipes designed for their children, and the involvement of their children in food preparation were assessed to inform a food parenting video game called Mommio. METHODS: A cross-sectional survey design was used. Eligibility criteria included mothers of 3- to 5-year-old children who reported difficulty getting their children to eat vegetables. Participants completed a demographic questionnaire with questions about their food preparation practices. They were asked to select up to 4 of the 10 provided recipes they wanted to try and to prepare and report back on their experiences. RESULTS: Most (46) of the 50 recipes included in Mommio's in-game recipe box were evaluated at least once and some up to 5 times with a total of 85 evaluations. This well-educated, mostly employed, sample of 27 mothers of preschoolers preferred simple, quick recipes. They ate primarily at home, made dinners from scratch, and indicated that the 46 recipes were generally simple, quick, and easy to prepare. Involvement in preparation enhanced their child's acceptance of the food. Prior food and preparation preferences influenced the children's acceptance of the dish at the ensuing meal. CONCLUSIONS: The high rate of home recipe preparation indicated that including a recipe selection and preparation component in a food parenting video game could be attractive and may enhance effectiveness. Mothers reported that the recipes provided were generally easy to prepare, tasted good, and the instructions were easy to understand, suggesting they could be helpful to the mothers when playing a vegetable parenting game. Some mothers reported that involving their children in recipe preparation influenced their children's willingness to eat the vegetables. The highest rated recipes are being included in the game, and mothers will be encouraged to involve their children in recipe preparation.

Behavioral interventions to promote adequate sleep among women: protocol for a systematic review and meta-analysis.

BACKGROUND: Short and poor sleep have been associated with adverse health outcomes in adults, such as overweight/obesity and type 2 diabetes, especially among women. Women therefore represent an important target for interventions aimed at improving sleep and such interventions have been advocated to enhance maternal, fetal, and infant health. This systematic review will assess the efficacy or effectiveness of behavioral interventions aimed at promoting adequate sleep among women. The primary outcomes will be changes in sleep duration and/or sleep quality from baseline to post-intervention and to the last available follow-up measured either through self-reports or objectively. Secondary outcomes will be assessing the behavior change techniques that are responsible for the changes in sleep duration and quality among women. METHODS: Behavioral interventions that are non-pharmacological and target either sleep directly or sleep hygiene behaviors will be included. Randomized controlled trials, quasi-experimental, and one-group pre-post studies will be included, but treated separately in the analyses, given that a limited number of studies on the topic of sleep is expected. MEDLINE/PubMed, PsycINFO, CINAHL, EMBASE, and Proquest Dissertations and Theses will be investigated. There will be no restriction on the year of publication of the articles, but we will include only the ones written in English or French. Two authors will independently assess articles for eligibility and will extract data using a standardized data extraction form that will have been previously pilot-tested. The quality of the studies will be assessed using the Effective Public Health Practice Project tool for quantitative study designs. The intervention procedures will be classified according to the latest validated taxonomy of behavior change techniques. If there is a sufficient number of studies (k > 5), a meta-analysis of the results will be performed with a random-effect model. If the heterogeneity is high (I 2 ≥ 75%), it will be investigated through sensitivity analyses and meta-regression. DISCUSSION: This review will provide valuable information to those interested in promoting adequate sleep among women and, hopefully, encourage additional research in this important field to promote maternal, fetal, and infant health. SYSTEMATIC REVIEW REGISTRATION: The study protocol was registered in PROSPERO in October 2016 (CRD42016049538).

Tree nut consumption is associated with better nutrient adequacy and diet quality in adults: National Health and Nutrition Examination Survey 2005-2010.

Nutrient adequacy of tree nut consumers has not been examined. The National Health and Nutrition Examination Survey 2005-2010 data were used to assess the association of tree nut consumption by adults 19+ years (n = 14,386) with nutrient adequacy and diet quality. Covariate adjusted usual intake was determined using two 24-h dietary recalls and the National Cancer Institute method. Percentages of the consumption groups below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was determined using the Healthy Eating Index-2005 (HEI) score. Usual intake data showed consumers of tree nuts had a lower percentage (p < 0.0001) of the population below the EAR for vitamins A (22 ± 5 vs. 49 ± 1), E (38 ± 4 vs. 94 ± 0.4) and C (17 ± 4 vs. 44 ± 1); folate (2.5 ± 1.5 vs. 12 ± 0.6); calcium (26 ± 3 vs. 44 ± 1); iron (3 ± 0.6 vs. 9 ± 0.4); magnesium (8 ± 1 vs. 60 ± 1); and zinc (1.5 ± 1 vs. 13 ± 1). Tree nut consumers had a higher percentage (p < 0.0001) of the population above the AI for fiber (33 ± 3 vs. 4 ± 0.3) and potassium (12 ± 3 mg vs. 2 ± 0.2 mg). HEI-2005 total score was higher (p < 0.0001) in tree nut consumers (61 ± 0.7 vs. 52 ± 0.3) than non-consumers. Health professionals should encourage the use of tree nuts as part of a dietary approach to healthy eating.

Ethnic disparities among food sources of energy and nutrients of public health concern and nutrients to limit in adults in the United States: NHANES 2003-2006.

BACKGROUND: Identification of current food sources of energy and nutrients among US non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican American (MA) adults is needed to help with public health efforts in implementing culturally sensitive and feasible dietary recommendations. OBJECTIVE: The objective of this study was to determine the food sources of energy and nutrients to limit [saturated fatty acids (SFA), added sugars, and sodium] and nutrients of public health concern (dietary fiber, vitamin D, calcium, and potassium) by NHW, NHB, and MA adults. DESIGN: This was a cross-sectional analysis of a nationally representative sample of NWH (n=4,811), NHB (2,062), and MA (n=1,950) adults 19+ years. The 2003-2006 NHANES 24-h recall (Day 1) dietary intake data were analyzed. An updated USDA Dietary Source Nutrient Database was developed using current food composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from food sources were sample-weighted. Percentages of total dietary intake contributed from food sources were ranked. RESULTS: Multiple differences in intake among ethnic groups were seen for energy and all nutrients examined. For example, energy intake was higher in MA as compared to NHB; SFA, added sugars, and sodium intakes were higher in NHW than NHB; dietary fiber was highest in MA and lowest in NHB; vitamin D was highest in NHW; calcium was lowest in NHB; and potassium was higher in NHW as compared to NHB. Food sources of these nutrients also varied. CONCLUSION: Identification of intake of nutrients to limit and of public health concern can help health professionals implement appropriate dietary recommendations and plan interventions that are ethnically appropriate.

The nutrient density approach to healthy eating: challenges and opportunities.

The term 'nutrient density' for foods/beverages has been used loosely to promote the Dietary Guidelines for Americans. The 2010 Dietary Guidelines for Americans defined 'all vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas (legumes), and nuts and seeds that are prepared without added solid fats, added sugars, and sodium' as nutrient dense. The 2010 Dietary Guidelines for Americans further states that nutrient-dense foods and beverages provide vitamins, minerals and other substances that may have positive health effects with relatively few (kilo)calories or kilojoules. Finally, the definition states nutrients and other beneficial substances have not been 'diluted' by the addition of energy from added solid fats, added sugars or by the solid fats naturally present in the food. However, the Dietary Guidelines Advisory Committee and other scientists have failed to clearly define 'nutrient density' or to provide criteria or indices that specify cut-offs for foods that are nutrient dense. Today, 'nutrient density' is a ubiquitous term used in the scientific literature, policy documents, marketing strategies and consumer messaging. However, the term remains ambiguous without a definitive or universal definition. Classifying or ranking foods according to their nutritional content is known as nutrient profiling. The goal of the present commentary is to address the research gaps that still exist before there can be a consensus on how best to define nutrient density, highlight the situation in the USA and relate this to wider, international efforts in nutrient profiling.

Correlates of adiposity among Latino preschool children.

BACKGROUND: Childhood obesity is at record high levels in the US and disproportionately affects Latino children; however, studies examining Latino preschool children's obesity-related risk factors are sparse. This study determined correlates of Latino preschoolers' (ages 3-5 years) adiposity to inform future obesity interventions and policies. METHODS: Latino preschoolers (n = 96) from 4 Head Start centers in Houston, Texas were recruited. Parents reported acculturation and neighborhood safety. Children's and parents' height and weight were measured. Children's television (TV) viewing was measured by TV diaries and physical activity by accelerometers. Linear regression was used with body mass index (BMI) z-score as the dependent variable and covariates sequentially added and retained in 4 blocks: 1) child age, gender, parent education, and BMI; 2) neighborhood safety and parent and child acculturation; 3) TV viewing; and 4) moderate-to-vigorous physical activity (MVPA). RESULTS: In the final model (n = 96), only neighborhood disorder (ß = 0.30, P = .005) and MVPA (ß = -0.21, P = .049) were significantly associated with BMI z-score. CONCLUSIONS: Among Latino preschoolers, higher neighborhood disorder and lower MVPA were associated with greater children's BMI z-scores.

Barriers and facilitators for consumer adherence to the dietary guidelines for Americans: the HEALTH study.

The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.

Validation of uniaxial and triaxial accelerometers for the assessment of physical activity in preschool children.

PURPOSE: Given the unique physical activity (PA) patterns of preschoolers, wearable electronic devices for quantitative assessment of physical activity require validation in this population. Study objective was to validate uniaxial and triaxial accelerometers in preschoolers. METHODS: Room calorimetry was performed over 3 hours in 64 preschoolers, wearing Actical, Actiheart, and RT3 accelerometers during play, slow, moderate, and fast translocation. Based on activity energy expenditure (AEE) and accelerometer counts, optimal thresholds for PA levels were determined by piecewise linear regression and discrimination boundary analysis. RESULTS: Established HR cutoffs in preschoolers for sedentary/light, light/moderate and moderate/vigorous levels were used to define AEE (0.015, 0.054, 0.076 kcal·kg-1·min-1) and PA ratio (PAR; 1.6, 2.9, 3.6) thresholds, and accelerometer thresholds. True positive predictive rates were 77%, 75%, and 76% for sedentary; 63%, 61%, and 65% for light; 34%, 52%, and 49% for moderate; 46%, 46%, and 49% for vigorous levels. Due to low positive predictive rates, we combined moderate and vigorous PA. Classification accuracy was improved overall and for the combined moderate-to-vigorous PA level (69%, 82%, 79%) for Actical, Actiheart, and RT3, respectively. CONCLUSION: Uniaxial and triaxial accelerometers are acceptable devices with similar classification accuracy for sedentary, light, and moderate-to-vigorous levels of PA in preschoolers.

Nutrition professionals are obligated to follow ethical guidelines when conducting industry-funded research.

Although disclosure of all funding sources, including those from industry, is mandatory for publication, it is no longer adequate. Given the skepticism surrounding industry-funded research, we need guidelines for communication with funding organizations and publication venues, and we need to safeguard and preserve research and scientific integrity.

Parenting practices are associated with fruit and vegetable consumption in pre-school children.

OBJECTIVE: Parents may influence children's fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children. DESIGN: An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004-5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children's consumption of F&V, after controlling for potential confounding factors. RESULTS: A three-cluster solution provided the best fit (R2 = 0.62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments' practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized beta = 0.09, P < 0.1; final model R2 = 0.17) after controlling for confounders, including parental feeding styles. CONCLUSIONS: Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children's F&V intake.

Diet quality varies by race/ethnicity of Head Start mothers.

BACKGROUND: Despite the key role that women from limited income families play as family food providers and their high risk for diet-related chronic diseases, there is a paucity of data about their diet quality and how it might vary by race/ethnicity. OBJECTIVE: To compare nutrient and food intakes of multiethnic mothers with children in Head Start from Texas and Alabama. DESIGN: Cross-sectional, secondary data analysis. METHODS: The sample was 603 mothers, 33% Hispanic American from Texas; 19% African American from Texas; 24% African American from Alabama; and 24% white from Alabama who were interviewed from fall 2004 to spring 2005. Diet quality was evaluated by averaging 24-hour dietary recalls from 3 nonconsecutive days and calculating the percent meeting the Estimated Average Requirement, the Dietary Guidelines for fat and added sugar, and the mean adequacy ratio for eight nutrients. For multiple comparisons, the least square means statement was used for general linear model procedures, adjusted for age, body mass index, and energy intake. RESULTS: The average mean adequacy ratio scores for diet quality were low overall, but 44% of Hispanic Americans had mean adequacy ratio scores <85, whereas 96% to 97% of other groups did. Most mothers exceeded 35% of energy from fat, with Hispanic Americans having the lowest percentage. Overall, 15% of mothers exceeded 25% of energy from added sugars, with Hispanic Americans having 5% with excess intakes. Energy intakes were highest for Hispanic Americans (2,017 kcal) and lowest for African Americans (1,340 kcal). The Hispanic Americans surveyed averaged 4.6 c fruit and vegetables per day compared to 3.2, 2.3, and 2.9 c/day among African Americans from Texas, African Americans from Alabama, and whites from Alabama, respectively. CONCLUSIONS: Despite limited food resources, Hispanic-American mothers consumed adequate amounts of fruit and vegetables. There was considerable variation in diet quality among race/ethnic groups on a low income budget.

Assessment of child and adolescent overweight and obesity.

Accurate appropriate assessment of overweight and obesity in children and adolescents is a critical aspect of contemporary medical care. However, physicians and other health care professionals may find this a somewhat thorny field to enter. The BMI has become the standard as a reliable indicator of overweight and obesity. The BMI is incomplete, however, without consideration of the complex behavioral factors that influence obesity. Because of limited time and resources, clinicians need to have quick, evidence-based interventions that can help patients and their families recognize the importance of reducing overweight and obesity and take action. In an era of fast food, computers, and DVDs, it is not easy to persuade patients to modify their diets and to become more physically active. Because research concerning effective assessment of childhood obesity contains many gaps, this report is intended to provide a comprehensive approach to assessment and to present the evidence available to support key aspects of assessment. The discussion and recommendations are based on >300 studies published since 1995, which examined an array of assessment tools. With this information, clinicians should find themselves better equipped to face the challenges of assessing childhood overweight and obesity accurately.

Efficiency of breakfast consumption patterns of ninth graders: nutrient-to-cost comparisons.

OBJECTIVE: To assess the efficiency of breakfast consumption patterns in terms of nutrient-to-cost comparisons. DESIGN: Twenty-four-hour dietary recalls were collected and food items named were priced (prices from local grocery stores and restaurants were averaged). Three breakfast consumption groups were identified: restaurant foods (fast foods), ready-to-eat (RTE) cereal, and other foods. SUBJECTS: Subjects consisted of 567 ninth-grade students (57% female, 86% white, mean age 14.8 years) in New Orleans, La. STATISTICAL ANALYSES: Analysis of variance techniques were used to test statistical significance for total nutrient intake levels, intake levels of nutrients per 1,000 kcal, and nutrient intake levels per dollar spent. Groupings were determined using the Duncan test or pairwise comparisons. RESULTS: Five percent of students ate a fast-food breakfast, 30% ate RTE cereal, and 65% ate other breakfasts. The mean cost of the breakfast meals was significantly (P<.0001) higher for the fast-food breakfast than for the RTE cereal breakfast and the other breakfast (fast>other=RTE). For every dollar spent, the RTE cereal and other breakfasts provided significantly more energy, carbohydrate, fiber, sugar, and protein than the fast-food breakfast. The other breakfast provided significantly (P<.001) more total and saturated fat per dollar than the fast-food or RTE cereal breakfasts. The RTE cereal breakfast provided significantly (P<.001) more, per dollar spent, of folic acid, iron, niacin, vitamins A and D, and zinc than the other 2 breakfast meals. APPLICATIONS: The importance consumers place on taste, cost, and convenience continues to influence types of foods consumed. Yet, their food choices may not be as efficient in terms of the nutrients obtained per dollar spent. With the increasing demands being placed on families and the decreasing amount of time being spent on food preparation, nutrition education programs should continue to promote a higher level of efficient food choices.